Provider Demographics
NPI:1124333273
Name:KITTLESON & KITTLESON, S.C.
Entity type:Organization
Organization Name:KITTLESON & KITTLESON, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:KITTLESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-744-3500
Mailing Address - Street 1:3527 E SQUIRE AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1426
Mailing Address - Country:US
Mailing Address - Phone:414-744-3500
Mailing Address - Fax:
Practice Address - Street 1:3527 E SQUIRE AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1426
Practice Address - Country:US
Practice Address - Phone:414-744-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4648-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty